The Dangers of Proton Pump Inhibitors | Chris Kresser
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The Dangers of Proton Pump Inhibitors

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Proton pump inhibitors rank among the top 10 prescribed classes of drugs and are commonly used to treat acid reflux, indigestion, and peptic ulcers. Although generally assumed to be safe, recent studies have shown that they have numerous side effects, from an altered gut environment and impaired nutrient absorption to an increased risk for cardiovascular events, kidney disease, and dementia.  

proton pump inhibitors
Prilosec and other protein pump inhibitors reduce the acidity of the stomach, but not without side effects. istock.com/Roel Smart

PPIs have become one of the most commonly prescribed classes of drugs in the industrialized world, despite increasingly frequent warnings by researchers about potential risks and complications.

A 2010 study found that of 946 patients receiving PPI therapy in a hospital setting, only 35 percent were prescribed PPIs for an appropriate upper GI diagnosis (1). In 2014, Americans filled more than 170 million prescriptions for acid blockers, falling only behind statins in total cost expenditure worldwide (2). PPIs are the most common of the acid blockers. They go by a variety of names but typically end in the suffix “-prazole” (omeprazole, pantoprazole, esomeprazole, etc.).

The purpose of this article is to provide an update to these earlier articles on heartburn and antacids, focusing on a number of scientific studies published in just the last few years. If you haven’t already, be sure to check out these previous blog posts.

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The Many Roles of Proton Pumps in the Body

Before we get into the potential harmful effects associated with PPIs, it’s important to understand what they do in the body.

PPIs are inhibitors of proton pumps, specifically the proton/potassium pump of parietal cells in the stomach. The theory is that heartburn and GERD (gastroesophageal reflux disease) are caused by excess production of stomach acid by these cells, so inhibiting this proton pump will reduce the acidity of the stomach and prevent the burning sensation of acid reflux or the formation of peptic ulcers.

But proton pumps aren’t limited to the stomach; they are present in just about every cell in your body. All of your cells, with the exception of red blood cells, have mitochondria that allow your body to metabolize carbohydrates and fat to produce energy. They do this by pumping protons across the membrane to generate a source of electric potential that can be harnessed to form ATP, the body’s main storage form of energy. Without an efficient proton-pumping system, the body must rely on anaerobic systems for energy production, leading to rapid fatigue.

Proton pumps are also important in the transport of various substances in the body, as we will see in detail in later sections. And while proton pump inhibitors are designed to interact specifically with the hydrogen/potassium pump in parietal cells of the stomach, research suggests that they likely have nonspecific binding capabilities (3). In other words, their chemical structure enables them to bind to other proton pumps as well. Though PPIs don’t stay in the blood for very long, their binding to proton pumps is essentially irreversible—they will continue to inhibit the proton pump until the master antioxidant glutathione is able to facilitate dissociation (4).

PPIs can harm your heart, brain, kidneys, and gut. There are other alternatives.

PPIs Alter the Gut

The composition of microbes that inhabit your gut is incredibly sensitive to changes in the local environment. pH, a measure of the acidity of an environment, is an important facet of gut health and a particularly potent regulator of microbial communities (5). PPI use reduces the amount of acid produced in the stomach, and ultimately the amount of stomach acid that reaches the gut. This causes a significant shift in the pH of the intestines.

Indeed, several recent studies have shown that PPI alters the gut microbiota by reducing its overall diversity (6,7). Opportunistic pathogens, including Enterococcus, Streptococcus, Staphylococcus, and E. coli, tended to be more prevalent in the guts of PPI users.

As stomach pH becomes less acidic, many ingested microorganisms that would normally be destroyed are able to make their way into the gut (8). Imhann and colleagues found that oral bacteria, such as the genus Rothia, were over-represented in the gut microbiota of PPI users (7). Those who used acid blockers also had an increased chance of acquiring Clostridium difficile, Campylobacter, Salmonella, Shigella, Listeria, and community-acquired pneumonia than those using other medications (9,10).

A 2013 study also found a significantly increased percentage of individuals with small intestinal bacterial overgrowth (SIBO) among PPI users (11). Together, these studies point to the vital importance of sufficient stomach acid for protecting against bacterial influx into the GI tract and maintaining an intestinal pH that supports GI health.

PPIs Impair Nutrient Absorption

Another consequence of long-term PPI use is impaired nutrient absorption, which I discussed extensively in a previous article. Stomach acid is essential for the absorption of many macro- and micronutrients. PPI users have been shown to have an increased risk of vitamin and mineral deficiencies, including vitamin B12, vitamin C, calcium, iron, and magnesium (12,13). Achlorhydria (a lack of stomach acid) and atrophic gastritis (stomach inflammation) allow for the overgrowth of bacteria, which compete with the host for consumption of micronutrients like vitamin B12 (14).

These micronutrients are particularly important for bone health. Studies have found an association between PPI use and total bone fractures in the elderly (15). While the association was modest, the findings were significant enough that the FDA felt it necessary to issue a news release in 2010 warning of the possible increased fracture risk (16). Since then, a more recent study has shown a similar association in young adult PPI users (17).

The effects of PPIs on bone health may be more nuanced than simply causing nutrient deficiency. Osteoclasts, the bone cells responsible for the resorption of calcium, also possess proton pumps, and their activity is thought to be directly affected by PPIs (18,19).

PPIs Increase the Risk of Cardiovascular Events

Several recent studies have also shed light on PPIs and the cardiovascular system. PPI users have been shown to have a significantly greater risk of heart attack than those on other antacid medication (20, 21). PPIs also reduce production of nitric oxide, a natural substance that promotes the dilation of blood vessels and improves blood flow (22).

PPIs may also damage blood vessel cells, as shown by a study published in May 2016. When researchers exposed cultured human blood vessel endothelial cells to esomeprazole, the cells seemed to age much more quickly, losing their ability to split into new cells. PPIs, which are designed to work especially well in acidic environments, seemed to inhibit an acidic compartment of the cell called the lysosome, which can be thought of as the cell’s “garbage disposal.” Without the ability to break down old proteins and other waste products of metabolism in lysosomes, “garbage” built up in the cells and inhibited their function (23).

PPIs Harm the Kidneys

The kidneys are also affected by PPIs. A study published in 2016 compared patients using PPIs to patients using H2 blockers, another common antacid drug. They showed that over the course of five years, those in the PPI group were 28 percent more likely to develop chronic kidney disease and 96 percent more likely to develop end-stage renal disease (24).

While the mechanism by which this occurs is unclear, we do know that proton pumps are present in the intercalated cells of the kidney. These proton pumps are responsible for moving protons into the urine, creating a gradient that allows for bicarbonate reabsorption into the blood (25). Bicarbonate is vitally important to maintaining proper blood pH.

PPIs Negatively Affect Cognitive Function

PPIs also impair cognitive function. A 2016 study found that regular PPI users had a 44 percent increased risk of dementia compared with those not using the drugs (26).

A different study published in 2015 that assessed cognitive function in PPI users versus controls found statistically significant impairment in visual memory, attention, executive function, and working and planning function among PPI users (27).

Several commonly prescribed PPIs, such as lansoprazole and omeprazole, have been reported to cross the blood-brain barrier. In mice, PPIs were observed to affect β- and γ-secretase enzymes, resulting in increased levels of amyloid β, a protein fragment that forms the plaques characteristic of Alzheimer’s disease (28).

Furthermore, communication between brain cells requires the action of proton pumps. Simplistically, neuron cells contain small vesicles, or pockets, of neurotransmitters. When a neuron is stimulated, the vesicle releases these neurotransmitters into the synaptic space, where they can then interact with receptors on other nearby neurons, transmitting the signal down the line. The neurotransmitters must then be taken back up by the neuron so that they can be released again in response to the next stimulus. The energy required for this reuptake process is driven by proton pumps (29). If PPIs bind to these proton pumps, cognitive abilities would certainly be impaired.

PPI Withdrawal Can Lead to Rebound Reflux

Your body is acutely sensitive changes in your physiology and is constantly trying to maintain a stable equilibrium, often termed homeostasis. In the case of PPIs, when it senses reduced stomach acid production, your body produces the hormone gastrin to try to compensate. Gastrin normally stimulates gastric (stomach) acid production.

Excess gastrin has in turn been shown to lead to an expansion of enterochromaffin-like cells (ECLs) (30). ECLs are found in the mucosa of the stomach in close proximity to parietal cells. A greater number of ECLs results in a greater amount of ECL hormones released that can interact with parietal cells. Parietal cells, as you may recall, are the cells responsible for stomach acid production via proton pumps. These parietal cells undergo hypertrophy, or an expansion in the size of each cell (31).

Larger parietal cells have more proton pumps and can produce larger amounts of stomach acid. This is termed “rebound hypersecretion,” or an overproduction of stomach acid after taking PPIs (32). This is why getting off PPI therapy is so difficult, because long-term use fundamentally changes the physiology of stomach cells. It also points to yet another instance where simply treating the symptoms of a condition fails to recognize and treat the underlying root cause.

Luckily, parietal cells are constantly undergoing renewal, with an average lifespan of only 54 days (33). So just because you took PPIs does not necessarily mean you are destined to rebound hypersecretion forever, as after a few months your stomach cells should have largely turned over. However, the repair mechanisms after PPI discontinuation have not been widely studied, and it is entirely possible that there are lasting effects.

Alternatives to PPIs

Collectively, these and many other studies suggest that PPIs are not as safe as they are made out to be. Frankly, it’s bordering on criminal that the FDA continues to allow these drugs to be prescribed as frequently as they are, and for durations of years or even decades in some cases, given the overwhelmingly large body of evidence documenting the potential harms associated with long-term PPI use.

If you’re convinced you should avoid PPIs, there are some alternatives (see my previous article for a more detailed discussion of these). Always consult with your medical practitioner before discontinuing the use of PPIs and be sure to reduce your dose gradually to avoid any withdrawal symptoms.

  1. Eat a low-carb Paleo diet
    Malabsorption of carbohydrates can lead to bacterial overgrowth, resulting in the bloating and increased abdominal pressure that drives acid reflux.
  2. Resolve low stomach acid and treat bacterial overgrowth
    Contrary to conventional wisdom, acid reflux is often due to too little stomach acid, which results in bacterial overgrowth.
Making diet and lifestyle changes is crucial for dealing with any type of digestive issue, GERD included. Switching to a low-carb Paleo diet and eating for gut health are generally much safer and more effective than taking acid-blocking medications like PPIs.

But, even with the knowledge that certain foods or habits are worsening GERD symptoms, it’s not easy for people to make lasting lifestyle changes. That’s because information isn’t enough to inspire change—but the empowering support of a health coach is.

At the ADAPT Health Coach Training Program, we teach you how to leverage mindset, presence, communication skills, and knowledge of Functional and ancestral health to help people who are trying to achieve their goals and change their lives. Our year-long, virtual course is designed to give you the tools and skills a successful health coach needs, while providing you with ample opportunities for hands-on practice.

It’s not easy to leave behind long-held habits. But as a health coach, your support could make the difference for someone who is trying to eliminate PPIs and alleviate their GERD symptoms. Health coaches are powerful, and they have the potential to change the lives of their clients. If that sounds like the right career for you, I encourage you to learn more about the ADAPT Health Coach Training Program.

445 Comments

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  1. I used nexium for several years at 3x the recommended dose until they stopped working. The specialist recommended the gruesome surgery used in severe cases. I had been following a macrobiotice diet that I found online which was recommended for reducing acid reflux symptoms. But it was useless. What saved me was Norm Robillard’s book, “Heartburn Cured”. As Chris suggests as well I went on a low carb diet and found that if I stayed at about 30 grams net carb a day my symptoms are minimal. It is very low but that was my only option. I also use digestive enzymes to help digestive efficiency.

    • If blocking proton pumps all over the body is not safe, then neither is blocking H2.

      The problem is not the proton pump nor the H2.

  2. I’ve been on PPI for two decades – on and off. Mainly on. Recently I experience an ER visit after not being able to breath – acid had sprayed my throat and larynx and I thought I was suffocating. Dr prescribed 40 mg Prilosec 2xday plus 300 mg Zantac at bedtime.
    After healing my throat and esophagus with this regime – Dr telling me to stay on the meds because an endoscopy revealed Barrett’s esophagus (no dysplasia).
    My issue: I want to be off these drugs – my gut is a wreck. My skin is bad – rosacea and eczema. My stomach feels bloated all the time.
    I’m eating a Paleo diet now for a few weeks and feeling much better – but when I stop taking the drugs, my acid reflux is a bear to deal with. I’m seeing a surgeon next week to see if my LES is damaged and that surgery is my ‘cure’.
    I feel like I’m going crazy! Has anyone stopped using PPIs been though you have Barrett’s?? Please share.

    • I “RETRAIN” the retrainable. Are you? How do I do it?

      With Mother Nature’s FARMACY….simple. On the way to becoming a “Doctor” but shifted to a Doctor of NATURAL healing via Sprouting, juicing, culturing, dehydration and Anaerobic Fermentation…[email protected]. I help those willing to help themselves. GI tract is OUT OF WACK. Food sensitivities. STOP going to Doctors of Death

    • I had a Nissan Fundiplication in 2002 thinking it would help my GERD and I wouldn’t have to be on medication. I lasted one year off the PPI’s and had to suffer another 13 years before I figured out a way to get off the PPI’s. Surgery is not the answer despite what the surgeon told me. He said he would guarantee that I would be fixed for life. Not true. I would love to find a Integrated GI doctor like Robyn Chutkin MD who has written several books on gut health. Thanks Chris for this forum and your help getting us all educated.

      • Study Andrew Saul PhD. Genius Othromolecular Medicine. Dr. Axe leaky gut. In order to cast aside years of DIS EASE you have to COMPLETELY change your life for the better. Whatever it takes. Half-assed measures deliver half-assed results.

    • Hi Stephen / Chris and others….I suffered from GERD for probably 30years, I’m now 63. I’ve had all the treatment stuff, both over the counter and prescription during that time …all giving only temporary relief ….nothing worked long term. Up to a couple of years ago I was on both Nexium 40gm and Prevacid together in a last ditch attempt by my doctor to counter the ” strong stomach acid”. I became very ill because of this. In desperation I read all I could on this matter including Chris’s Kresser articles and I can now say I’m over my GERD and all its effects. This is not what I expected. The ” magic bullet ” for me was and is Apple Cider Vinegar. It seems too simple but that’s it. I take it at each main meal. Please read up on it. For me it truely was a “miracle”. Cheers

      • Geoff, I’m really happy for you that you learned a better way to deal with GERD. My sister-in-law used apple cider vinegar for her GERD, and it worked great. I’ve read different places online that acv is great for stomach problems, and it seems to work for so many. Unfortunately, as soon as I try it (with water or in a mixed with other suggested liquids or spices), I get the worst case of heartburn! I don’t even think it tastes that bad, so it would be great if it worked for me. Did acv cause you any problems when you first tried it?

        • I’m 59 and after 2 years of Paleo diet, using pea protein to raise my protein intake, and near zero carbs and gluten for 1 year, now adding back carbs, and ocassionally gluten, paired with twice a week strength training, I have been able reduce from 4 blood pressure Meds to 3 blood pressure Meds.

          I’m currently reducing the Bisoprolol/Concor as I daily track my blood pressure sometimes up to 3 times a day – one upon waking up, one after ingesting two cups of coffee in the morning, and once before sleep.

          After reducing these blood pressure Meds, I have reduced PPI from daily to twice a week, with one (not the usual two) Veragel on days when I don’t take PPI. I think it’s not being carb and gluten free but also one must also do more strength training and increase pure protein intake. I’m targeting to be Meds free eventually.. And I also hope to reduce need for supplements.

          I still dare not reduce the statins I’m taking because I still believe I have to maintain my LDL cholesterol below 100 (or 2.6 depending on whichever measurement) as I have 3 stents already put in for 10years.. I’m worried of my clogged arteries acting up.. Chris, is there a forum where I can read about people with stents attempting to reduce statins maintaining the 100/2.6 LDL cholesterol reading. No read about replacing statins with red yeast but I understand that red yeast is also a statin. Thank you in advance.

        • In reponse to Terri_Dp

          Hi Terri….great to hear about your sister-in-law success with ACV. I started with two teaspoon of ACV in a glass of water, with each main meal, which gave nearly immediate relief. I didn’t have any issues in transferring from the PPI to the ACV …I was just glad to get off the PPI in the ends as I was getting quite ill using them.
          Liquid form was not the most conveniant way to take ACV, so I checked out if there was a pill form…and yes there is. I use Apple Cider Vinegar Tabs made by Source Naturals . I get them posted to me here in Melbourne Australia through Iherb which is an online suppliments company. Each pill is 500gm equivalent to 2 teaspoons of ACV there is no additives preservatives etc…I take one with each meal and can eat anything unlike whist on the PPI…as mentioned this has been a total success for me re the end of GERD and its harmful medications. It worked for me a hopefully you. If you try it I’d love to know how you go….good luck. Cheers

          • Thank you so much for the information! I had no idea I could get acv in any other form. I will definitely get some and see how they work for me.

            • Thanks Terry….yes,I thought a tablet form would be the answer, so I did a web search and the “iherb” site came up . It has a few to choose from but the “Source Naturals” fitted the dosage etc that I read was needed in the liquid form. Each bottle has 180 tabs at approx AU $4.00 per bottle and lasts me a month. Not at all a big expense ! As I said I take one with each main meal and have been doing so for the last 2 years. You might get some “kick back ” at first coming of the the other Meds, I didn’t , I just stopped “cold turkey ” as anything would have been better. It changed everything for me , I felt like a got my life back. When I told my doctor about what I had done , he just said …” good, what ever works” Please let me know how you go , I would be very interested. Best Wishes ..Geoff.

              • I tried the acv for about a week before I decided it wasn’t worth the pain. I don’t know if I’ve had any worse heartburn in my life. I am so disappointed it didn’t work! I know from experience that what works for one won’t work for another, so I’ll try some other things I’ve seen here and see if they help.

        • reponse to Terri_Dp

          Hi Terri….great to hear about your sister-in-law success with ACV. I started with two teaspoon of ACV in a glass of water, with each main meal, which gave nearly immediate relief. I didn’t have any issues in transferring from the PPI to the ACV …I was just glad to get off the PPI in the ends as I was getting quite ill using them.
          Liquid form was not the most conveniant way to take ACV, so I checked out if there was a pill form…and yes there is. I use Apple Cider Vinegar Tabs made by Source Naturals . I get them posted to me here in Melbourne Australia through Iherb which is an online suppliments company. Each pill is 500gm equivalent to 2 teaspoons of ACV there is no additives preservatives etc…I take one with each meal and can eat anything unlike whist on the PPI…as mentioned this has been a total success for me re the end of GERD and its harmful medications. It worked for me a hopefully you. If you try it I’d love to know how you go….good luck. Cheers

    • My husband was diagnosed with Barrets esophagus about 5 years ago. He was on Nexium for a year and his reflux symptoms had subsided, but after reading of the dangers of PPIs, I urged him to stop taking it. Instead, he took HCL pills with meals to help his digestion, and when he’d have occasional heartburn, he took papaya enzyme tablets for relief. At his follow-up endoscopy, his gastroenterologist said everything looked about the same, no change since his last endo. He told my husband to keep doing what he’s been doing. (We didn’t tell the doctor that he’d been off of Nexium for the past 3 years.)

  3. Chris, thanks so much for delving into this topic!

    I’ve had reflux since childhood and I’m now in my late 50s. I took a variety of antacids over the years. 9 years ago I was put on Protonix by an ENT doc who suspected that my ear and throat problems were due to reflux. I was told by my gastroenterologist that many people do well on it for an extended period of time. (I’d also had an EGD to stretch scar tissue near my esophageal sphincter.) The ENT was correct in her dx and the ear/throat issues improved on Protonix. But after 6 years on the drug I felt like I was dying… anxiety, depression, very susceptible to viral illnesses and it took me weeks to get oversimplified colds. I had severe muscle cramping in my diaphragm when I’d cough… also severe cramping (sometimes leaving bruises) in my toes, feet, legs, and hands. I was starting to get tingling sensation in my arms. I couldn’t sleep even when exhausted and to top it all off I had developed severe osteopenia. I’d travelled to Africa several times and each time I was the team member who would get sick with gastroenteritis despite precautions.

    I decided I was tired of having my symptoms treated while the root cause was never investigated so I took myself off Protonix cold turkey. It hurt like crazy for about two weeks then began to ease up. My daughter urged me to try the GAPS diet in an attempt to begin to heal my gut. It helped. I then gradually reintroduced foods. I felt better on a Paleo diet but couldn’t keep my weight up on strict Paleo. It was a couple of years before I could tolerate very many carbs. I developed Barrett’s Esophagus during that time. It’s now 3.5 years later and I am much better. Have finally put some weight back on. I eat a modified Paleo diet these days. I was tested for food intolerances and cut a few of the offending foods out which improved my stomach inflammation. My last EGD showed NO Barrett’s! I feel pretty good these days. I still take Magnesium religiously because even one day missed and my legs start to cramp up. So some things are probably still screwy with my mineral absorption. But yeah, I do better on a mostly Paleo diet.

  4. I’ve been on Nexium for 6 to 8 years and did not know of the dangers as described here. Two years ago I was diagnosed with Barrett’s Esophagus; this year I had a biopsy which was negative. I’d like to know if it is still advisable to wean off due to the precancerous condition. I brought 38 pages of your article regarding GERD to the Gastroenterologist and he would not even look at it. Are there good Naturopathic Doctors in the Phoenix metro area you could recommend who are in line with your thinking about these studies? Thanks, Mary

    • My experience is almost exactly the same. GI Doctor wants me on PPIs. No real listening for alternatives. Weary!

      • Yep, my GI doc was super irritated that I had done any research and looked around on the internet, and had no interest in hearing about food intolerances I’d figured out. Is also irritated I refuse to take PPIs or get scoped (barium swallow didn’t show any problems and I’m just 36). We have a looooong way to go…

        • Mine doctor at least let me cut down to every other day. I have Barrett’s, have had it for many years and have been on Nexium for as long as I can remember. Developed major gut issues and food sensitivities. I am now eating Paleo and feel great. It’s been about a year. My last scope was good and I don’t need another one for 3 years! He still wants me to take the PPI every other day but my goal is to wean myself off them. I think I can talk him into it. (as long as my diet remains in check) I do notice reflux if I cheat. I take a probiotic every day. Not sure how much it helps but something is working. 🙂

      • Doctors sell drugs, that is what they are taught to do and paid to do. just a salary should be enough, but they rewarded by their paymasters with kickbacks of all kinds.

        Meanwhile, relying on the dodgiest of their industry financed trials, the more they sell the bigger the pay-out.

        Fines for fraud within the pharmaceutical industry for the last decade are six billion and counting.

        I am sure there are well meaning doctors, but if they are guided by a corrupt industry, what chance is there of truth.

        Any visit to a doctor should come with a health warning.

    • I am in the same boat Mary and also live in the Phoenix area. I have been on Protonix for about 5 years and was switched to Dexilant for about the last 5 years (twice a day). Paleo and better than Paleo helped but after trying to wean off the nastiest reflux started to occur again. We need some alternative(s)

    • Mary, I don’t personally know of any Naturopathic Physicians in the Phoenix area, but you might try searching for one in your area by using http://www.aznma.org/, which is the web site for Arizona Naturopathic Medical Association.

  5. I have been on Omeprezole for at least 12 years. Now notice huge stomach which I have addressed with probiotics and is getting better. I switched to Zantac 150 after reading the negatives on Omeprezole and it does not touch my heartburn. The pain can be pretty bad. So I take Tums and that stops it for awhile. I am also Type 2 diabetic and I have a lot of stress being the only caregiver to my husband who is totally disabled. So you think a Paleo diet will help me? I should also take enzymes? Where would I purchase a comprehensive book on Paleo eating or at least a name of the best book to get? Any help would be much appreciated as my doctor just wrote a RX for Omeprezole again and no discussion of something else to try. Thanks.

    • Yes, a paleo diet will help and from experience, I truly believe it is the only solution. I have suffered from GERD since the birth of my daughter 19 years ago. I have tried PPI’s on and off and I always get muscle cramping. I have tried a low carb diet twice in the past 4 years, and each time the GERD symptoms have disappeared. I now continue to eat small low carb portions several times per day. If I do eat a large meal, I have symptoms, so I have no desire anymore to eat large portions and I keep the carbs down. I prefer not to take any medications. I will turn 50 this year, and I currently take no prescription drugs. Again, I truly believe that you are what you eat!

      • Wow how did you do it? Just go paleo, but aren’t fats bad for GERD it slows down transit time of food in the stomach so reflux is more likely. And by eating protein this ups the need for acids as well.

        Ive been on prilosec for 21yrs and started tapering off and no GERD or stomach pain BUT duodenal ache and small intestine twinges, thinking of tapering off and adding slipper elm and other herbs to protect the mucus lining of my gut, bck on the 20mg of prilosec cause of the tapering off aches, I want to heal my gut for 6 weeks then strt another taper off of the PPI.

  6. I was diagnosed with Barrets Esophogus (BE) end of last year after an endoscopy. The GI doctor immediately but me on Omeprazole. I have been taking them since with no heartburn but reacetly started to worry about the potential long term effects. I have been having more stomach issues since I started taking them and have gotten sick more often. Not sure if coincidence but I believe it could be related to this medication. Another doctor also added famotidine on top of it. So now I’m taking both. I was told by my mother in law who’s a top pharmacist for 2 decades most people only go on Omeprozole for 6 months then transition off to famotidine. My GI doctor said I must stay on it “forever” because BE is irreversible and serious concern for becoming pre-cancerous. I really want to unravel this long line of health garbage, I’m only 36, have a young child and another on the the way and now I”m getting scared. What the heck do I do?? I don’t want cancer and I don’t want these pills to fundamentally change my gut health!

  7. I had been on PPI’s for several years. Have been off now for three months. With the help of a Natrapath who gave me supplements such as melatonin and many others I am finally down to just taking one Zantac a day. It was very difficult. I was sick with stacks after every meal, but I persisted. Finally seeing the light. My advice is to get help and power through. It can be done.

  8. I have been on Nexium for over 8 years now. I tried to stop about 5 years ago but probably went too quickly as I ended up with erosive esophagitis. Went back on them…plus Zantac..stopped the Zantac but not the Nexium. The doctors just keep prescribing them…crazy..
    Now I have issues with my thyroid, heart and blood sugar. And the doctors just want to give me more pills !!
    I see a Naturapath doctor next week.I am trying to get off the Nexium..went to every other day for now..watching what I eat..no gluten,sugar, never ate dairy.
    Hopefully the Naturapath Doctor will be helpful.

  9. After being put on ppi’s in my early 30s I now am off and well after 11 years on them. VLC diet combined with every kind of gut assisting / gas reducing natural meds has done the trick. Try reading the “low carb miracle” to get off ppi’s and all of Chis’s other gut articles. When weaning off ppi I recommend cutting your regular pill in half with a knife and taking it that way for a while (just half dose) then space the dose out to 30 hours then 36 to 40 to 48, I was able to wean off after one week but you need to do very low carb diet for at least 1-2 weeks as you wean off. 4 months after dropping the ppi’s I am acid free most days and only get mild symptoms some days that I manage easily without ppi

  10. Unfortunately, I was allergic to the PPIs that my doctor put me on (actually several doctors) who assumed I had acid reflux because I had a constant cough. As I rarely take drugs, (they
    are toxins) I only took a couple of tablets before stopping the original prescription. A week later, my face and ears swelled and became very hot. The doc put me on oral prednisone to stop the reaction. Two years later, another doctor assumed the same, and prescribed that poisonous purple pill, Nexium, which I took for several days and then quit. A week later, I was in the ER with swelling face and tongue for 3 hours and a dose of epinephrine. Two years after that, my EMT doctor prescribed Prilosec – I took only one capsule and was in the ER later that afternoon with the same reaction as above. As it was the ONLY prescription drug I was on and it showed up on the hospital’s computer monitor, we finally realized the PPI was cause for the symptoms. Since taking that original dose in 2005, my health started a nose dive that continues even to today, 11 years later – with a resulting plethora of symptoms – none of which the medical community have any clue as to how to treat or resolve: i.e., I deal with the following symptoms every day: heat and sun intolerance (we have to keep the thermostat at 70 or cooler at all times, which is expensive as we live on the Gulf Coast), and, since I’m sun intolerant, I have to stay inside most of the time – my husband and I can’t go to the beach or take a walk without my face, ears and neck becoming feverishly hot, red and swelling); I have also developed histaminosis and have a very limiting diet (multiple, MULTIPLE food allergies) where if I eat any offending foods, have the same reaction as above; I have edema in my legs and feet which requires I use lymphedema boots for an hour each day to address the swelling; I also have significant eczema and other skin problems; plus intestinal pain and swelling along with several other very concerning side effects. It has had a devastating effect on my and my husband’s quality of life – taking a drug you may be allergic to can affect more than just yourself.
    I’ve taken the time to share this with you all so that you can be informed of the really horrible side effects these drugs can cause for about 1-2% of users (check out side effects in Nexium’s information sheet – in its usual 4point type – and you’ll see that they KNOW that about 1% of us will be COLLATERAL DAMAGE and have our health impaired or destroyed by taking this drug. And the fact they’ve stated such in their 4 point type, pretty much protects them from any fiscal responsibility for the damage they do. I’m now 65 years old and I don’t intend to spend the rest of my life trying to sue a pharmaceutical company with very, very deep pockets. Besides, it took me five years to determine what was causing my symptoms because of the delayed reaction on my body which would put me outside of the time limit most states provide for suing a company. The doctors kept telling me it SIMPLY COULDN’T BE the drug because it wouldn’t cause a delayed reaction. WRONG! Everybody’s BODY is different.
    Let me suggest some alternatives to PPI’s: have a packet of natural (not smoked or salty) almonds with you and chew a few when you feel you are getting “acid-y”. Or carry a container of sliced cantaloupe or cucumbers with you and nosh on them.
    Foods that are naturally alkaline will help counteract the acid
    causing your problem. But be sure to check and see if acid is the problem – maybe you just don’t have enough HCI in your stomach (it naturally declines as you age). Take a sip of apple cider vinegar when you’re having a bout and see if it helps or worsens your problem. If it helps, you’re possibly low in hydrochloric acid. If it makes it worse, eat something alkaline. The ironic thing is, I didn’t have reflux. I had a milk allergy that made me cough. Beware of doctors that ASSUME you have an illness. Demand that testing be conducted and a diagnosis be confirmed BEFORE you take any prescription. Drugs are not innocuous substances.
    Take it from someone who knows.

  11. Hi Chris,
    I was diagnosed with GERD in April of 2012 and have been on and off PPIs ever since. I have a Hiatus Hernia and erosive esophagitis. I have used Nexium, Tecta and Dexilant. At first, the PPIs worked well for my GERD. But then I started having abdominal pain and extreme bloating. So I went off PPIs for close to 1 year. As I was having a lot of heartburn and esophageal pain, I went back on the meds for approx. 9 months. Again, I suffered severe bloating and abdominal pain. I did a lot of research and came across your articles about PPIs and GERD. I followed your advise and started a low carb diet. I then discontinued the Dexilant in April 2016. Also at the same time elevated the head of my bed by 6″ (Inclined Bed Therapy). At first, I experienced extreme heartburn. But I persevered and the heartburn and indigestion stopped after approx. 1 month. I am currently in the process of improving my gut health. Would you recommend a probiotic and a digestive enzyme and if so, what kind would you suggest? I would really like to stay off the PPIs but I recently had an endoscopy and am worried that the specialist will recommend I go back on the meds.

  12. My son was diagnosed with a hiatal hernia, which allows acid to flow up and into the lower part of his esophagus irritating it to the point that it goes into spasms and will not allow food or liquid to go through. There is a strong family history of this issue. His grandfather and great grandfather suffered from similar symptoms. His father had surgery to repair the same issue 15 years ago rather than live on PPI’s, which were the only thing that kept the inflammation down. Multiple times before his surgery he had to have his throat stretched because of the narrowing caused by the constant irritation. Back then there wasn’t much info about the risks of PPI’s, but we were concerned about the affects of long-term use all the same. Now we are so glad that he had the surgery. Still, my son’s symptoms are not as bad as his father’s were, and he does take PPI’s occasionally when the irritation in his esophagus is to the point that he has problems swallowing his food. Taking Prevacid two or three days in a row seems to calm everything back down. He can go for weeks and weeks in between with no issues. He never complains of heartburn. The only symptom he has is his throat closing up on him. What I want to know is this–does intermittent PPI use carry significant risk? Dietary changes and such just don’t cut it when it comes to a hiatal hernia, but the surgery is pretty extreme. It would be an easy choice if he were as bad as his father and had to take PPI’s every day, but that isn’t the case.

    • Dawn, this is very left field but your son’s symptoms sound very similar to those that I experienced (I too have a hiatal hernia). The throat closing up symptom (which for me went from intermittent throat discomfort to chronic dysphagia over time), turned out to be a vitamin B12 deficiency (as Chris goes into in great depth in other parts of this site). The only way I was able to figure this out was through having a vitamin B12 injection for completely unrelated (or so I thought) reasons and waking up the next day being able to swallow again, then having it wear off over a couple of weeks, going back to the doctor for another B12 shot, waking up the next morning and bingo able to swallow again! I used Chris’s protocol on this site methyl B12, TMG, Metafolin and potassium (since I couldn’t get my doctor to listen and since then have figured out that the methyl form of B12 works much better than cyano injections anyway), and six weeks later, absolutely no sign of any further swallowing issues/dysphagia. I also did Chris’s 14Four program and have since been just doing the Specific Carbohydrate Diet to ensure full gut healing occurs, since I can’t get any doctors to listen I have even been writing a blog about this ‘miracle’. I think that the B12 deficiency runs in families a bit, it certainly does in mine. I don’t take PPI’s nor would I ever (my mother was diagnosed with early onset dementia 11 years ago after 20+ years of Losec (Omeprazole) use, I think she was low in B12 anyway and chronic usage of this drug meant she struggled to get B12 from the food she was eating. But have a look at one of the lists of “symptoms of B12 deficiency” out there, there are over 100 symptoms, and my bet is that you’d find your son has a bunch of the other symptoms too.

  13. Very good article. I would like to have seen some encouragement and tips for those like myself who were on PPI’s and have been working on restoring their health. The dementia link is something I wasn’t aware of, but must be due to the gut flora disregulation. I believe my SIBO diagnosis was from taking PPI’s for years. I weaned myself off of them six years ago, and I am still working on healing my digestion. I have been very strict Paleo for two years. Some people like myself can’t do an 80/20 or 90/10 and have to be “Paleo Perfectionists”.

  14. I was prescribed a PPI for gastric erosion, I took one on two consecutive evenings as prescribed. I then had severe diarrhoea and headaches, so severe that I was unable to leave home for three days. It took me three weeks to overcome the diarrhoea and I am resolved to find a more natural method to heal myself. I have also just found out that I have H Pylori which requires two antibiotics plus a PPI to treat conventionally, antibiotics cause acute Candida so I will not be taking that route either.

  15. I am on 40mg of omeprazole for a peptic ulcer. I was rushed to the hospital from severe anemia because of the ulcer. I know this PPI is supposed to repair the ulcer, but it’s been 10 weeks and my GI doc wants me to stay on for at least another month when I will have my 3rd endoscopy since the hospital stay. Do I even need this 3rd one Chris? And although I know it will only be 14 weeks on the PPI I’m wondering how soon the bad effects take place. I am currently by the advisement of my doctor taking B12, magnesium, D3 (and I get sun), C and a probiotic. Any advice from anyone would be great. Btw the only difference I’ve noticed in my health is joint pain in my feet and increased headaches all which my diet has previously fixed. Been Paleo for 5 years and I’m 48.

  16. I had eaten paleo/real food for several years, including homemade sauerkraut and hemp milk kefir. Well I never felt heartburn but finally got esophageal pain because of esophagitis. I guess I am the silent GERD type. So frustrating….many functional doctors discuss preventing heartburn and GERD, but rarely discuss healing esophagitis, because eating sauerkraut can hurt the damaged area. Luckily the dr didn’t see anything requiring a biopsy but I have taken PPI for 3 months to heal. I am slowly getting off it now and having a follow-up scope next week but I still feel a little something on the esophagus. I have been doing natural treatments too. I’m 57 so maybe the sphincter got weak from low acid but I was eating right so it’s frustrating. He said I had a small hiatal hernia too so it’s scary that the acid, while very important, will continue to hurt my esophagus. These side effects are scary, but cancer is too. Any advice would be appreciated.

    • Sometimes that ‘something’ on the esophagus is a bit of neuropathy caused by a vitamin B12 deficiency (have a look at Chris’s explanations around testing for B12 levels, before you believe your doctor who says your B12 levels are ‘normal’. I also can’t eat fermented foods or drinks like kombuscha and am paleo. Have a look at the Specific Carbohydrate Diet and also instead of PPI’s try Betaine Hydrochloride with Pepsin supplements, they are incredible and despite my hiatal hernia etc… I don’t need PPI’s.

      • Thanks, Diana. I have been taking methyl B12 but maybe it’s not enough. I’m just scared not knowing which foods, however healthy, may be triggers for me. Not a single one seems to make it worse. I’ve just been told that acidic/vinegar types will hurt the esophagus more. Sometimes I even wish I had heartburn so I’d know what
        helps and what hurts. I have been adding slippery elm tea and bone broth to heal the esophagitis.
        As I wean off PPI I will start adding HCL and see what happens. ENT told me to be scoped every year since I don’t feel anything until the esophagus is damaged.

  17. Very interesting article. in 1988 I had a Partial Gastrectomy followed in 1992 with a Total Gastrectomy for Peptic Ulcers of which 12 were found after the Partial. Six months after the TG acid reflex started and has been a problem ever since. After numorous tests no real conclusion as to why this is happening. I am on Pantoprazole 40mg x 1 and Ranitidine 300mg x 1, for the forseeable future unless someone comes up with something else. So having been told I wouldn’t need tablets any more I’m still on them, so this article is worrying. I live in the UK and am under St Thomas’ Hospital in London.

  18. I was on PPIs prescribed by my doctor for 8 months to treat GERD. I developed numbness and a burning sensation in my feet and hands, joint pain, inflammation and panic attacks. After reading Martie Whitteken’s book Natural Alternatives to Nexium, Maalox, Tagamet, Prilosec & other acid blockers, I realized I needed to change what I was doing. I changed my diet to quasi Paleo and my reflux symptoms subsided within a week. My other symptoms have gradually diminished over the course of a year.
    There are alternatives to the PPI poisons. Diet and nutrition are the key and the guts to try alternatives to conventional medicine.

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